Authorization for Audio/Visual Recording/Observation
Services through the Talley Family Counseling Center are provided by master’s
level counselors-in-training. The counselors-in-training receive training in mental health
and family counseling from faculty members in the Department of Counseling and
Student Affairs. The directors of the TFCC are faculty members from the Department of
Counseling and Student Affairs.
The clinic is a teaching and research facility. For training and research purposes
and to ensure that you receive the best services possible, we request your permission to
record counseling sessions using audiovisual equipment, and/or to engage in live
observation.
I/we authorize Talley Family Counseling Clinic to use any recordings of
myself/ourselves and my/our family for the purpose of: review by the counselor,
evaluation of the counselor, supervision by the counselor’s supervisor, consultation with
peers, research, and/or teaching. Upon written notice I/we may have any or all
audio/visual recordings erased, and/or restrict their use to one or more of the above stated
purposes.
Client/Parent/Guardian (circle one): ____________________________ Date: ________
Client/Parent/Guardian (circle one): ____________________________ Date: ________
Other participants:
____________________________ Date: ________
____________________________ Date: ________
Witness to signature(s):
____________________________ Date: ________